Primer: histopathology for the clinician—how to interpret biopsy information for gastritis

Abstract

Gastroenterologists can be frustrated, at times, by surgical pathology reports of gastritis that either do not match what was seen endoscopically, or do not indicate the presence of a specific disease. This might be because of one or more factors. First, it has been well established that the correlation between the endoscopic diagnosis of gastritis and histologic gastritis is poor. Second, there are a limited number of well-known histologic gastritides that yield specific diagnoses. Reports that are purely descriptive are, therefore, common, and might require discussion between endoscopist and pathologist.

Key Points

• Good endoscopic–histologic correlation for gastric biopsies is to be expected only ∼50% of the time

• Endoscopically normal mucosa often has histologic inflammation, and endoscopically inflamed mucosa is often histologically normal

• Pathology reports of gastritis can be divided into two broad groups: specific gastritis diagnoses and descriptive nonspecific diagnoses

• Specific diagnoses are more likely when clinical and endoscopic information and clinical questions are sent with the biopsy to the pathology laboratory

• Clinicians should ask the pathologist for an explanation when they receive a histologic diagnosis of gastritis that does not match any of the described gastritides